Dying, and Alone, in Myanmar

http://www.nytimes.com/2009/04/01/world/asia/01iht-myanmar.html

BANGKOK — The most heartbreaking moment for doctors and nurses treating people with H.I.V./AIDS in Myanmar is the arrival of a new patient. Running short of funds and medications, clinics have started turning dying people away.


“They continue to knock on our doors, even though we can’t take in most of them,” said Joe Belliveau, operations manager of the international aid group Médecins Sans Frontières.

The 23 clinics run by the group, also known as Doctors Without Borders, are the primary dispensers in Myanmar of the antiretroviral drugs that can prolong the lives of those infected with H.I.V., the virus that leads to AIDS. So most of the people it cannot treat are likely to die.

The people of Myanmar, a country that seems to have been marked for suffering, receive little foreign assistance — the country ranks among the lowest per capita for such aid in the world. The same is true for assistance for people with H.I.V./AIDS.



Médecins Sans Frontières estimates that 240,000 people are currently infected with H.I.V. in Myanmar and that 76,000 are in urgent need of antiretroviral drugs. Every year, about 25,000 people with the virus die.

The group’s clinics have been providing 11,000 people with the antiretroviral drugs that keep them alive. The longer they live, the more treatment they need. The group says it is unable to increase its budget there without taking money away from people in need elsewhere.

Last year it made the difficult decision to stop accepting any new patients in order to continue treating the old ones. It has opened its doors a little bit this year, accepting 3,000 new patients, still a fraction of those in need.

“When we stopped last July it was devastating for the staff,“ Belliveau said. “They couldn’t even treat the ones dying on their doorsteps.”

This year, the United Nations-backed Global Fund To Fight AIDS, Tuberculosis and Malaria has applied for government permits to bring antiretroviral drugs into Myanmar, and the number of people receiving treatment is likely to rise.

But that will only be one step. Fewer than 20 percent of those who need the drugs receive them, either from international groups or, in very small amounts, from the government, Médecins Sans Frontières said in a report released in November.

When a photographer visited a clinic a few months ago, he found anguish and fatalism among the people who had not received the drugs.

“I can only live longer if I have ART,” said one 28-year-old woman, referring to the antiretroviral treatment she needs. “Most of the money and possessions I had are already gone. My family sends me food from the village, but they cannot support my treatment. If I get ART I will be able to live, if not, I will die.”

In one room the photographer found a 49-year-old man, gaunt and weak, sitting on the side of a bed. He had no family, and because of the stigma of the disease he was ashamed to tell his friends or co-workers about it.

“The worst thing for me is the loneliness,” he said.

Two weeks after his picture was taken, he was dead.